Asthma is a chronic disorder of the air passage and involves an interaction of airflow obstruction, hyper bronchial responsiveness, and an underlying inflammation. The scale on which these three components occur determines the severity of the condition as well as a patient’s response to treatment. The prevalence and mortality rates associated with asthma have been on the rise for the past two decades, despite improvements in medical therapy (ALA, 2017). The management of both chronic and acute asthma is complex and evolving. Understanding the pathophysiology of both types of asthma will lead to better recognition and as well as characterization of populations at risk of fatal asthma. Although asthma is classified into two categories namely acute and chronic asthma, several similarities run across the board. The symptoms are typically the same, some of which include, coughing, wheezing, dyspnea, and chest tightness.
Pathophysiological mechanism of acute asthma
Acute asthma exacerbation results when an inhaled antigen attaches itself to a mast cell that has performed IgE. Immunoglobulin E (IgE) are antibodies that are manufactured by the immune system (Plus, 2017). If an individual suffers from an allergy, for example, the immune system overreacts to an allergen by generating antibodies known as Immunoglobin E (IgE). These antibodies move to cells that release chemicals, hence resulting in an allergic reaction. Once the inhaled antigen bines to the mast cells, the cells begin to degranulate and release inflammatory mediators such as histamine, prostaglandins, bradykinins, leukotrienes, interleukins, and platelet-activating factor (PAF). The mediators cause bronchospasm of the passageway of the smooth muscles as well as edema that arises from increased capillary permeability (Huether & McCance, 2015). Besides, the goblet cells increase the secretion of mucus that causes constriction in the airway.
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Pathophysiological mechanism of chronic asthma
This condition is mainly established by the increased sensitivity to type 2 inflammation, high sensitivity to viral infections, bacterial colonization or vitiated lung development. In this disorder, the dendritic cells, mast cells eosinophils, lymphocytes, B lymphocytes, T helper two cells, neutrophils, and basophils increase the intractable inflammation of the bronchial mucosa and the hyperresponsiveness of the air passageways.
A factor that may impact the pathophysiology of acute and chronic asthma
The severity of asthma is dependent on various variables. The most common factor, however, is the age. According to multiple studies, asthma is presently the most prevalent chronic disease among children, affecting approximately five million children in the US and accounting for about 200, 000 hospitalizations each year (Briscoe, 2012). The National Cooperative Inner-City Asthma Study phase 1, for instance, established that there were high rates of morbidity and functional limitation among inner-city asthmatic children (Glissman, 2012). Besides, there were an estimated four million asthma exacerbations in 2000, leading to 728, 000 emergency department admissions, 214, 000 hospitalizations, and 223 deaths in children aged between 0 to 17 years. The pathophysiology for both types of asthma in children is typically the same as the adults. Nevertheless, this article will deal with the diagnosis and treatment of asthma
Diagnosis
The initial investigation for asthma includes the following:
• Pulmonary function tests by use of spirometry that confirms the diagnosis. Spirometry demonstrates specific airflow obstruction. Nevertheless, this technique is performed at the time when the patient shows some symptoms and measures the Forced Expiratory Volume in the first second (FEV1) as well as the Forced Vital Capacity (FVC) both at rest and after inhaling a short-acting beta2agonist such as salbutamol (Hammer & McPhee, 2014).
A patient is confirmed to have asthma if he or she has the following results
• The FEV1 is lower than 80 percent the predicted value based on the patient’s height and weight.
• The ratio of FEV1/FVC is below 75 percent of the lower limit of normal for the patient’s age and size
• The FEV1 rises more than 12 percent after the inhalation of beta2agonist such as butamol
Treatment
The treatment for both types of asthma involves the implementation of general measures and administration of medication.
General measures
• Emergency-room care and hospitalization in the case of severe attacks
• Psychotherapy or counseling if the asthmatic patient also suffers from stress
• Remove allergens and irritants at home or place of work
• The patient to keep regular medication with him or her at all times
• Stay indoors during high allergen times
Medications
The treatment of acute asthma involves the use of an inhaled bronchodilator and oxygen. Also, intravenous muscle relaxants, as well as steroids, may be used in some cases (Huether & McCance, 2015). In case the attack is severe and prolonged, the patient is hospitalized for intensive treatment. On the other hand, treatment for chronic asthma involves the use of inhaled bronchodilators and reducing the exposure to causative agents. People who experience frequent attacks ought to use inhaled steroids, muscle relaxants, mast cell stabilizers, and oral steroids. Usually, aggressive treatment of pulmonary diseases is recommended as well as immunization against influenza and pneumococcal pneumonia.
References
American Lung Association (ALA) ® . (2017). American Lung Association . Retrieved 30 December 2017, from http://www.lung.org/
Briscoe, K. (2012). Thetford: mother of Bradley Wilson, who died of asthma attack, told there was nothing she could have done. East Anglian Daily Times. Retrieved from http://www.eadt.co.uk/news/thetford_mother_of_bradley_wilson_who_died_of_asthma_attack_told_there_was_nothing_she_could_have_done_1_1375128
Glissman, B. (2012). Girl's death puts focus on asthma's broader grip. Omaha World-Herald. Retrieved from http://www.omaha.com/article/20120521/LIVEWELL01/305219975
Hammer, G. D., & McPhee, S. J. (2014). Pathophysiology of Disease: An Introduction to Clinical Medicine 7/E (pp. 145-146). McGraw Hill Professional.
Huether, S. E., & McCance, K. L. (2015). Understanding Pathophysiology-E-Book . Elsevier Health Sciences.
Plus, G. (2017). Asthma and Allergy Foundation of America . Aafa.org . Retrieved 30 December 2017, from http://www.aafa.org/
